Category Archives: high blood pressure

Blood pressure is like what Mark Twain said about the weather, “Everybody talks about it, but nobody does anything about it.” Well almost. I have found that blood pressure is one of those subjects that is widely and wildly misunderstood. I used to think it was like grey hair on old people. Everybody has it. I was dead wrong.

Few assumptions are more dangerous than this one: If you have high blood pressure, you know it.

Doctors refer to high blood pressure, or hypertension, as a silent killer because it rarely produces warning signs.

Significant reductions in the risk of mild cognitive impairment (MCI)*, and the combination of MCI and dementia**, have been shown for the first time through aggressive lowering of systolic blood pressure in new research results from the federally-funded SPRINT MIND Study reported at the Alzheimer’s Association International Conference (AAIC) in Chicago.

“This is the first randomized clinical trial to demonstrate a reduction in new cases of MCI alone and the combined risk of MCI plus all-cause dementia,” said Jeff D. Williamson, MD, MHS, Professor of Internal Medicine and Epidemiology and Chief, Section on Gerontology and Geriatric Medicine at Wake Forest School of Medicine. Williamson reported these results at AAIC 2018.

The results of this large-scale, long-term clinical trial provide the strongest evidence to date about reducing risk of MCI and dementia through the treatment of high blood pressure, which is one of the leading causes of cardiovascular disease worldwide.

“This study shows more conclusively than ever before that there are things you can do — especially regarding cardiovascular disease risk factors — to reduce your risk of MCI and dementia,” said Maria C. Carrillo, PhD, Alzheimer’s Association Chief Science Officer. “To reduce new cases of MCI and dementia globally we must do everything we can — as professionals and individuals — to reduce blood pressure to the levels indicated in this study, which we know is beneficial to cardiovascular risk.”

Blood pressure is the force of the blood pushed against the the wall of the arteries …

Over 500 new gene regions that influence people’s blood pressure have been discovered in the largest global genetic study of blood pressure to date, led by Queen Mary University of London and Imperial College London.

Involving more than one million participants, the results more than triple the number of blood pressure gene regions to over 1,000 and means that almost a third of the estimated heritability for blood pressure is now explained.

High blood pressure is a major risk factor for stroke and heart disease and was responsible for an estimated 7.8 million deaths worldwide in 2015. While lifestyle risk factors are relatively well-known and include obesity, smoking, alcohol and high salt-intake, high blood pressure is also highly heritable through genetics. Prior to this study however, the genetic architecture of blood pressure had not been well understood.Continue reading →

One of my favorite songs as a kid in the 1940’s was “Don’t fence me in.”
Here are some of the lyrics:Oh, give me land, lots of land under starry skies above
Don’t fence me in
Let me ride through the wide open country that I love
Don’t fence me in

It appears I still feel that way, particularly when it comes to exercise. Working out in the health club really turns me off.

People who bike regularly, either for pleasure or as a way to commute, appear to have a lower risk of cardiovascular disease, according to two separate studies published simultaneously in the American Heart Association’s journal Circulation and Journal of the American Heart Association, the AHA/ASA’s Open Access Journal.

My dog and me rounding a turn on Northerly Island, just south of the Chicago Loop.

While structured cycling as part of a formal workout routine is already known to guard against cardiovascular illness, little is known about the effects of habitual biking done for leisure or as a way to commute. Together, the findings from the newly published studies suggest that leisure and commuter biking may be an important public health strategy in large-scale efforts to reduce cardiovascular risk.

In the Circulation study, 45,000 Danish adults (aged 50 to 65) who regularly biked for recreation or to commute had between 11 percent and 18 percent fewer heart attacks during a 20-year follow-up (1993-2013).

The analysis showed that as little as half an hour of biking per week provided some protection against coronary artery disease. Additionally, people who took up biking during the first five years the authors followed them had about a 25 percent lower risk of developing heart disease, compared with those who remained non-bikers in the subsequent 15-year period.

Researchers caution that their findings do not prove definitively that riding a bike for leisure or to and from work can prevent heart attacks. However, they say, the lower number of cardiovascular events observed among those who biked on a regular basis is a strong indicator that such activity can boost cardiovascular health.

“Finding time for exercise can be challenging for many people, so clinicians working in the field of cardiovascular risk prevention should consider promoting cycling as a mode of transportation,” said Anders Grøntved, M.Sc., M.P.H., Ph.D., senior study author and associate professor of physical activity epidemiology at the University of Southern Denmark.

Researchers also tracked participants’ overall exercise habits, activity levels and frequency of bicycle riding, along with heart disease risk factors, such as blood pressure, weight, cholesterol, smoking, diet and alcohol consumption. Participants were asked to provide information about cycling habits at the onset of the study and once more in five years.

In all, there were 2,892 heart attacks during the 20-year follow-up. Researchers estimate that more than 7 percent of all heart attacks could have been averted by taking up cycling and keeping it up on a regular basis.

“Because recreational and commuter biking is an easy way to make physical activity part of one’s routine in a non-structured and informal fashion, based on the results, public health authorities, governments and employers ought to consider initiatives that promote bicycle riding as a way to support large-scale cardiovascular disease prevention efforts,” said Kim Blond, M.Sc, lead author and research assistant at the University of Southern Denmark.

The Journal of the American Heart Association study revealed that middle-aged and older Swedish adults who biked to work were less likely than non-bikers to be obese, have high cholesterol, high blood pressure or pre-diabetes — all critical drivers of cardiovascular risk.

Researchers followed more than 20,000 people in their 40s, 50s and 60s over 10 years and monitored their commuting habits, weight, cholesterol levels, blood glucose and blood pressure.

At the beginning of the study, active commuters (biked to work) were 15 percent less likely to be obese, 13 percent less likely have high blood pressure, 15 percent less likely to have high cholesterol and 12 percent less likely to have pre-diabetes or diabetes, compared with passive commuters (used public transportation or drove to work).

During a follow-up exam 10 years later, the portion of study participants who switched from passive commuting to active commuting also had an improved risk profile. They were less likely to be obese, have diabetes, hypertension or elevated cholesterol, compared with non-bikers.

Collectively, at the 10-year follow-up, those who maintained biking or took up biking at some point had a 39-percent lower risk of obesity, 11 percent lower risk of high blood pressure, 20 percent lower risk of high cholesterol and 18 percent lower diabetes risk.

“We found active commuting, which has the additional advantages of being time-efficient, cheaper and environmentally friendly is also great for your health,” said Paul Franks, Ph.D., senior study author, professor in the Department of Clinical Sciences at Lund University in Sweden and guest professor at Umeå University in Sweden. “The multiple advantages of active commuting over structured exercise may help clinicians convey a message that many patients will embrace more readily than being told to join a gym, go for a jog or join a sports team.”

Researchers noted that there was no minimum amount of time or distance required to reduce one’s risk, even though people who biked longer or more often experienced small additional gains in risk reduction.

Because the study was observational, it is difficult to establish a cause-and-effect relationship between improved cardiovascular health and commuter biking, but the findings do indicate a strong cardio-protective effect from cycling.

Based on their findings, researchers also estimated that maintaining biking habits or switching from passive commuting to biking may have prevented 24 percent of obesity cases, 6 percent of hypertension diagnoses, 13 percent of high cholesterol diagnoses, and 11 percent of the cases of diabetes.

“The really good news here is that it’s never too late to benefit from an active lifestyle,” Franks said. “People who switched from passive to active commuting saw considerable gains in their cardiovascular health.”

As regular readers know I pretty much ride my bike every day here in Chicago. I say ‘pretty much’ because several years ago, my doctor told me that I shouldn’t be doing my big rides in high temperatures. I said that I felt I was in great shape and my body could handle it. She answered that she said the same thing to her 40-year-old patients. Extreme heat puts the body under special stress and it is not wise to actively exercise in those conditions.

Here I am riding with my dog in the annual Bike the Drive ride in Chicago down Lake Shore Drive. As a Memorial Day ride, the temps rarely hit high extremes.

Now, it seems that now only high temp extremes, but also large intra-day changes can be damaging, according to a study being presented at the American College of Cardiology’s 67th Annual Scientific Session. It states that large day-to-day swings in temperature were associated with significantly more heart attacks in a study being presented at the American College of Cardiology’s 67th Annual Scientific Session.

Regarding extreme weather events, Hedvig Andersson, MD, a cardiology researcher at the University of Michigan and the study’s lead author, said, “Our study suggests that such fluctuations in outdoor temperature could potentially lead to an increased number of heart attacks and affect global cardiac health in the future.”

There is a large body of evidence showing that outdoor temperature affects the rate of heart attacks, with cold weather bringing the highest risk, but most previous studies have focused on overall daily temperatures. This new study is among the first to examine associations with sudden temperature changes. Continue reading →

Medical researchers at Trinity College Dublin, Ireland, are advising caution when treating blood pressure in some older people — after results from a study contrasted with recent advice from the U.S. to attempt to aggressively lower blood pressure in all adults to targets of 120mmHg.

Researchers from the Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin, in collaboration with Beaumont Hospital, Dublin, have recently published the findings in the Journal of the American Medical Association (JAMA Internal Medicine).

A large randomized blood pressure trial led by U.S. investigators — the Systolic blood Pressure Intervention Trial (SPRINT) — demonstrated that lowering systolic blood pressure to levels of 120mmHg or less compared with 140mmHg or less in adults (over 50 years with cardiovascular risk) significantly reduced death (from all causes and from heart failure and heart attacks). The study also reported that common side effects of low blood pressure such as falls, injuries, blackouts, and drops in blood pressure after standing were not increased by aggressive treatment — even in people over 75 years old.

Because the latter findings were clinically counter intuitive, the TILDA team tested whether they held true outside of a trial setting. Focusing on people in Ireland over 75 years, they examined rates of falls, injuries, blackouts and excessive drops in standing blood pressure in those who met the criteria for the treatment proposed in SPRINT and were followed up with for 3½ years — the same time period as SPRINT.

The researchers reported starkly contrasting results — falls and blackouts were up to five times higher than reported in SPRINT and drops in blood pressure on standing were almost double that reported in SPRINT. Therefore, in people over 75 years, intensive lowering of blood pressure to 120mmHg could result in harm and TILDA researchers recommend that a better understanding of who, over 75 years, will or will not benefit, is necessary before widespread adaptation of the SPRINT results.

The TILDA team is now assessing how best to determine which people may benefit from SPRINT, and which people are more at risk from aggressive blood pressure lowering.

First author of the journal article, Research Fellow at TILDA, Dr. Donal Sexton, said: “SPRINT was a landmark study of hypertension treatment. While the benefits of lowering blood pressure seen in this study are not in dispute, we are highlighting to physicians that we need to be cognizant of the fact that the trial was not powered for adverse events such as falls causing injury. Physicians ought not to expect a similarly low rate of adverse events in clinical practice as was observed in the trial when lowering blood pressure in older people. Overall what we are saying is that the risks and benefits of lowering blood pressure should be individualized for each patient.”

Professor Rose Anne Kenny, founding Principal Investigator with TILDA and lead author of the journal article commented: “Our work and that of other groups has shown that low blood pressure and particularly drops in standing blood pressure are linked not only to falls, fractures and fall- and blackout-related injuries, but also to depression and possibly other brain health disorders.”

“These outcomes can seriously impact on independence and quality of life and we advise caution in applying the SPRINT recommendations to everyone over 75 years without detailed assessment of an individual’s risk versus possible benefit until such a time as we can provide more clarity re treatment.”

Advances in technology have made it possible for us to take measurements of our body that previously we had to rely on doctor visits to get done. This is a positive development that saves us time and money – on the assumption that we can do as accurate a measurement as the hospital. Seems that is not necessarily the case with home blood pressure monitors.

Seventy per cent of readings from home blood pressure monitors are unacceptably inaccurate, which could cause serious implications for people who rely on them to make informed health decisions, new UAlberta research reveals.

“High blood pressure is the number one cause of death and disability in the world,” said medical researcher Jennifer Ringrose, who led the research study. “Monitoring for and treating hypertension can decrease the consequences of this disease. We need to make sure that home blood pressure readings are accurate.” (my emphasis)Continue reading →

As a 77 year old, I was heartened to learn that a lot of the damage expected by aging could be controlled by attention to the American Heart Association’s (AHA) seven steps in yesterday’s post.

Study Highlights

High blood pressure and increased blood vessel stiffness are often considered common parts of aging.

Having healthy arteries into one’s 70s and beyond is challenging and depends on modifiable lifestyle factors, not necessarily genetics.

Having the blood vessels of a healthy 20-year-old into one’s 70s is possible but difficult in Western culture, according to new research in the American Heart Association’s journal Hypertension.

“For the most part, it’s not genetic factors that stiffen the body’s network of blood vessels during aging. Modifiable lifestyle factors – like those identified in the American Heart Association’s Life’s Simple 7 – are the leading culprits,” said study author Teemu J. Niiranen, M.D., research fellow at Boston University School of Medicine, Framingham Heart Study, Framingham, Massachusetts. Continue reading →

Here is yet another reason to be sad about the SAD – Standard American Diet.

A new study by Keck School of Medicine of the University of Southern California researcher links increased dietary potassium with lower hypertension.

Consuming potassium-rich foods like sweet potatoes, avocados, spinach, beans, bananas — and even coffee — could be key to lowering blood pressure, according to a USC researcher.

“Decreasing sodium intake is a well-established way to lower blood pressure,” said Alicia McDonough, professor of cell and neurobiology at the Keck School of Medicine of USC, “but evidence suggests that increasing dietary potassium may have an equally important effect on hypertension.” Continue reading →

Regular readers know how much I follow developments in the study of the brain. Here is some fresh fascinating info from Johns Hopkins.

Summary: Researchers report orthostatic hypotension could cause lasting damage to the brain because it can reduce blood flow to the brain.

Middle-aged people who experience temporary blood pressure drops that often cause dizziness upon standing up may be at an increased risk of developing cognitive decline and dementia 20 years later, new Johns Hopkins Bloomberg School of Public Health research suggests.

The findings, being presented March 10 at the American Heart Association’s EPI|LIFESTYLE 2017 Scientific Sessions in Portland, Ore., suggest that these temporary episodes – known as orthostatic hypotension – may cause lasting damage, possibly because they reduce needed blood flow to the brain. Previous research has suggested a connection between orthostatic hypotension and cognitive decline in older people, but this appears to be the first to look at long-term associations. (my emphasis)

According to the American Heart Association (AHA): • Poor sleep – even if you don’t have sleep apnea – may be linked to higher risks of developing an irregular heartbeat. • In addition, getting less rapid-eye movement (REM) sleep may also be linked to higher atrial fibrillation risks.

Disruptions in sleep may be raising your risks of an irregular heartbeat, known as atrial fibrillation (AF), according to preliminary research presented at the American Heart Association’s Scientific Sessions 2016. Continue reading →

Blood pressure is one of the critical and least understood aspects of our health. For that reason, I am reblogging this post I wrote five years ago. This is a perfect example of ‘what you don’t know can hurt you.’

Bergman explained that blood pressure depends on the strength of the heartbeat, thickness and volume of the blood, the elasticity of the artery walls and general health. It is the arterial pressure of the circulation. It is a dynamic process and fluctuates all day.

She said that blood pressure (BP) varies between a maximum (systolic) pressure – working phase. And the minimum (diastolic) pressure – the resting phase. Average blood pressure decreases as the blood moves away from the heart through the arteries. It drops most rapidly around the small arteries and continues to decrease as it moves through the capillaries and back to the heart through the veins.

My family history of Alzheimer’s Disease and dementia popped this news item up onto my radar screen.

Before considering problems with high blood pressure, let’s understand what it is. Blood pressure is the force of the blood pushed against the the wall of the arteries. It depends on the strength of the heartbeat, thickness and volume of the blood, the elasticity of the artery walls and general health. It is the arterial pressure of the circulation, a dynamic process that fluctuates all day.

As a senior citizen, I know that high blood pressure is very widespread. I used to think it was about the same as having grey hair. But, I was wrong.

Harvard Medical School reports “Blood pressure has long been one of the best markers of your health. It is a number you can remember and monitor. High blood pressure (hypertension) is linked to a greater risk of heart attacks and strokes.

“About one out of three adults has high blood pressure, which is usually defined as a reading of 140/90 millimeters of mercury (mm Hg) or higher.

“The first, or upper, number (systolic pressure) represents the pressure inside the arteries when the heart beats, and the second, or lower, number (diastolic pressure) is the pressure between beats when the heart rests.

“Blood pressure rises with age because of increasing stiffness of large arteries, long-term buildup of plaque, and the effects of other diseases involving the heart and blood vessels. Typically, more attention is given to the diastolic reading as a major risk factor for cardiovascular disease. Continue reading →

You can have high blood pressure, or hypertension, and still feel just fine, according to the National Institute on Aging (NIA). That’s because high blood pressure often does not cause signs of illness that you can see or feel. But, high blood pressure, sometimes called “the silent killer,” is very common in older people and a major health problem. If high blood pressure isn’t controlled with lifestyle changes and medicine, it can lead to stroke, heart disease, eye problems, kidney failure, and other health problems. High blood pressure can also cause shortness of breath during light physical activity or exercise. My emphasis

What Is Blood Pressure?
Blood pressure is the force of blood pushing against the walls of arteries. When the doctor measures your blood pressure, the results are given in two numbers. The first number, called systolic blood pressure, is the pressure caused by your heart pushing out blood. The second number, called diastolic blood pressure, is the pressure when your heart fills with blood. The safest range, often called normal blood pressure, is a systolic blood pressure of less than 120 and a diastolic blood pressure of less than 80. This is stated as 120/80.

Do You Have High Blood Pressure?
One reason to have regular visits to the doctor is to have your blood pressure checked. The doctor will say your blood pressure is high when it measures 140/90 or higher at two or more checkups. He or she may ask you to check your blood pressure at home at different times of the day. If the pressure stays high, even when you are relaxed, the doctor may suggest exercise, changes in your diet, and medications.
The term “prehypertension” describes people whose blood pressure is slightly higher than normal—for example, the first number (systolic) is between 120 and 139, or the second number (diastolic) is between 80 and 89. Prehypertension can put you at risk for developing high blood pressure. Your doctor will probably want you to make changes in your day-to-day habits to try to lower your blood pressure.

What if Just the First Number Is High?
For older people, the first number (systolic) often is 140 or greater, but the second number (diastolic) is less than 90. This problem is called isolated systolic hypertension. It is the most common form of high blood pressure in older people and can lead to serious health problems. Isolated systolic hypertension is treated in the same way as regular high blood pressure but often requires more than one type of blood pressure medication. If your systolic pressure is 140 or higher, ask your doctor how you can lower it. Continue reading →